The present disclosure relates to an electrosurgical instrument for closing epidermis or body tissue sections in a human or animal and, more particularly, to a bipolar electrosurgical instrument for energizing needles for wound sealing.
There are six main purposes of wound and, particularly, skin closure: 1) the elimination of dead space where infection or hematoma can occur, 2) realigning tissues correctly to reduce remodeling, 3) to hold aligned tissue together utilizing the correct tension until healing has occurred, 4) to avoid the introduction of infection, 5) to enhance cosmetic results, and 6) to speed up the ability of the patient to return to normal activity. In order to accomplish these goals, a number of techniques are currently in common use. These include sutures, staples, tissue adhesives, adhesive skin closure strips and hair ties. Each of these methods has their disadvantages.
Sutures are the oldest and still the most common method of wound closure. This method has some advantages that are worth noting. Any mistakes can be easily rectified, all types of wounds (deep or superficial) can be closed with sutures, and they are mechanically strong (12 times stronger than wounds closed with tissue adhesives). However, there are disadvantages as well. Suturing is time consuming and requires a good amount of skill. Strict aseptic techniques must be maintained to avoid contamination of the wound—tissue must be tied together with the appropriate tensile strength (too loose can cause tissue to not heal, too tight can damage the tissue), additional damage caused by the needle, and suturing does not provide complete homeostasis.
Staples are the second most popular method of skin closure. Staples and sutures are very similar in patient comfort as well as cosmetic results. Stapling, however, is the fastest method of skin closure, has the lowest level of tissue reactivity, less chance of infection, and does not require a local anesthetic. However, staples are often more expensive than sutures and can only be used to close superficial skin layers, require a follow up visit to remove the staples and it can be difficult to properly align the tissue, thus increasing the chance of scar deformity.
Tissue adhesives have been around for approximately 60 years and are starting to become more popular. While they are substantially more expensive that sutures or staples, they can break under high tensile force and are not particularly useful for areas that will be washed frequently. Advantageously, gluing wounds together is a relatively easy skill to perfect. Glue provides a waterproof seal, is quicker than suturing and anesthetics generally are not needed.
Adhesive skin closure strips are available in normal, reinforced or elasticized form. These strips come in predetermined lengths or they can come in rolls and be cut down to the appropriate size. These strips have the advantages of being easy to use, reduce the risk of infection, reduce the need for anesthetic, can be used in conjunction with either sutures or staples to enhance mechanical strength, are comfortable and produce good cosmetic results. However, adhesive skin closure strips have the disadvantage that they do not adhere well to sweaty, oily or hairy areas. They also cannot be used on deep wounds without the reinforcement of sutures. Further, they are complex to use when the wound is not straight, and they are generally unsuitable for use over joints.
The zipper is a fairly newly introduced method of skin sealing. The zipper is applied with an adhesive strip to both sides of a wound and then closed. The zipper can be rapidly applied without anesthetic and give good aesthetic results. Advantageously, the zipper is substantially less costly than staples or suture kits and can also reduce the chance of infection. However, the zipper can detach if it becomes too dirty. It also cannot be used on wounds that have more than a 20 degree curvature, and can only be used for deeper wounds without sutures.
The hair apposition technique is applicable to scalp wounds. In this technique, hair is taken from both sides of a scalp wound and tied across the wound to achieve tissue apposition. The knot can then be secured with benzoic tincture, tissue adhesives or adhesive sprays. This method can only be used with hair that is approximately 3 cm long or longer. Additionally, the technique can only be used on superficial wounds.